Bariatric Surgery: An Overview

We don’t yet have a magic pill for weight loss, but for those who have 100 pounds or more to lose, there is help: bariatric surgery.

Weight-Loss Surgery: The Options
Bariatric surgery, or weight-loss surgery, involves shrinking the stomach to promote weight loss. With gastric bypass surgery, the size of the stomach is reduced to a small pouch, and food that’s eaten is sent directly from the pouch to the small intestine. Another common bariatric surgery, gastric band, involves putting a band around the top of the stomach to restrict food intake. While gastric bypass is permanent, a gastric band can be adjusted and even removed.
Neither weight-loss surgery is appropriate for someone with just a few pounds to lose. Rather, it’s for people who are about 100 pounds overweight, or who have a body mass index of 35 or higher with health problems, says Thomas H. Magnuson, MD, director of the Johns Hopkins Center for Bariatric Surgery in Baltimore.
The cost is $20,000 to $30,000; however, Medicare and most insurance companies cover bariatric surgery for those who meet the criteria, Dr. Magnuson says.
Weight-Loss Surgery: The Pros of Surgery
Here’s why bariatric surgery may be a good choice for those who meet the criteria: It helps you drop a lot of weight quickly. When you’re carrying around an extra 100 pounds or more, you have to lose a lot to see health improvements. While the general population can benefit from a 10 percent loss in weight, someone who is 400 pounds probably won’t get enough health benefits from losing 40 or 50 pounds, Magnuson explains.
That’s where surgery lends a hand. People who have gastric bypass surgery lose about 70 percent of their weight during the first year, while people who have adjustable gastric band surgery lose 40 to 50 percent of their weight over two to three years, Magnuson says. You lose weight without feeling hungry. “It’s a comfortable thing to have a small stomach,” he says. “They get a signal that they’re full from eating a small amount of food.”
It can be a lifesaver. “The goal is not necessarily to lose a bunch of weight,” Magnuson says. “It’s to get rid of the medical problems associated with having the extra weight.” Often, diabetes improves to the point that people are able to go off their medication within a couple of weeks of surgery.
Studies have found that:

• Diabetes is resolved in 77 percent of people who have bariatric surgery, with 86 percent seeing an improvement.
• Blood pressure improves in 79 percent of people who have the surgery and actually resolves in 62 percent of people.
• Cholesterol levels improve in at least 70 percent of people.
• Sleep apnea is resolved in 86 percent of people.

Also, women who were unable to get pregnant before surgery because of abnormal menstrual periods often find that their cycles become more regular and they’re able to start a family, Magnuson says.
Your quality of life improves. Going from 300 to 150 pounds means being able to play outside with your kids, comfortably fitting into a seat on an airplane, and being able to travel and move with ease.
Weight-Loss Surgery: The Cons of Surgery
Life after weight-loss surgery won’t be perfect. You may experience problems if you’re not careful about your diet:
If you’re not a vigilant eater, there are side effects. After surgery, your stomach will only be about one ounce in size. That’s about the size of a small egg or golf ball, so you can only eat a half-cup to one cup of food at any one sitting, Magnuson explains. If you eat more than your stomach can hold, it can cause vomiting.
There’s also something called “dumping syndrome.” If you have a large amount of something sugary, such as a full bottle of soda, you may feel cramping and wooziness, followed by diarrhea. This happens because the small bowel isn’t used to having fluid with a lot of sugar dumped right into it — your stomach no longer acts as a reservoir first, explains Magnuson, adding that this is the kind of mistake patients usually only make once.
There’s a risk of nutritional deficiency. For gastric bypass procedures, most of the calcium and iron in your food isn’t absorbed. Your doctor will recommend that you take vitamins, particularly vitamin B12, calcium, and iron if you’re a woman.
You should be diligent about not using any other forms of substance abuse. If you’ve been abusing food, it may take some work after surgery not to replace food with alcohol or drugs.
Weight-loss surgery is a big step toward meeting your goal of getting to a healthy weight. Weighing the pros and cons will help you decide if it’s the right step for you.